There are a wide variety of
palliative treatments for
esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life.
Stent placement is currently the most widely used treatment modality for palliation of
dysphagia from
esophageal cancer.
Stent placement offers a rapid relief of
dysphagia, however, the rate of complications (late
hemorrhage) and recurrent
dysphagia (
stent migration,
tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux
stents for the prevention of
gastro-esophageal reflux is currently too low.
Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant
dysphagia.
Nd:YAG laser is a relatively effective and safe treatment modality, although
laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose
brachytherapy compares favorably to
stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative
chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative
chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of
esophageal cancer, the measurement of quality of life is an important outcome measure. The
cancer-specific EORTC QLQ-C30 and the
esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with
stent placement or
brachytherapy in combination with
chemotherapy may be indicated.